Where’s the “Better Care” in Senate Health Bill?

This year Congressional leadership and the Trump Administration have disrupted health insurance markets with uncertainty. Their vision is to undermine and ultimately do away with the Affordable Care Act (ACA) and to obfuscate the dramatic coverage gains realized over the last seven years. While focusing on this plan, the GOP has not addressed how to make communities healthier, how to make our health care system more responsive to patients’ needs, or how to improve life expectancy. Considering that the US ranks 50th of the 55 nations on the Bloomberg Health-Care Efficiency Index, those are the issues that we should focus on.

Instead of building on the ACA to address health disparities, fully embrace population health, and use future technologies to improve our collective well-being, our leaders debated what services we shouldn’t pay for in women’s health and how much extra we should allow insurance companies to charge older people. Instead of designing rules encouraging the system to use precious health care dollars to achieve better patient outcomes, the debate revolved around how quickly to eviscerate the half-century federal-state partnership that supports Medicaid. And that’s the central feature of the draft bill, the Better Care Reconciliation Act (BCRA), unveiled by the Senate last week.

Disease and disability do not come in red and blue versions. Health is so deeply personal. It’s about where we can afford to live, where we can work, what we can feed our children, and where our children can live and thrive. It’s about how we care for those who can’t care for themselves.

The BCRA will not make us healthier. It won’t make us more competitive in global markets. It won’t improve productivity. And in the end, it won’t cost us less money. For a brief news cycle, it will give Congress a box to check on passing an anti-affordable health care bill.

Genuine leadership requires vision, courage, honesty, and yes, trade-offs, so let’s have the real discussion about trade-offs. The bills offered in both the House and the Senate will reduce taxes for people in the top income brackets, but the bills won’t improve the health or the well-being of America. The bottom line is that this isn’t better care — it is about providing tax breaks for some of the wealthiest Americans.

Dr. Sandra R. Hernández is president and CEO of the California Health Care Foundation. Prior to joining CHCF, Sandra was CEO of The San Francisco Foundation, which she led for 16 years. She previously served as director of public health for the City and County of San Francisco. She also co-chaired San Francisco’s Universal Healthcare Council, which designed Healthy San Francisco, an innovative health access program for the uninsured.

Sandra is an assistant clinical professor at the University of California, San Francisco, School of Medicine. She practiced at San Francisco General Hospital in the AIDS clinic from 1984 to 2016. She was appointed by Governor Jerry Brown to the Covered California board of directors in February 2018. She currently serves on the Betty Irene Moore School of Nursing Advisory Council at UC Davis and the UC Regents Committee on Health Services. Sandra served on the External Advisory Committee at the Stanford Center for Population Health Sciences in 2016. Sandra is a graduate of Yale University, the Tufts School of Medicine, and the certificate program for senior executives in state and local government at Harvard University’s John F. Kennedy School of Government.